Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options

Khan, Waseem-Ullah; Appukuttan, Aswin; Loh, Charles Yuen Yung

doi:10.1016/j.jpra.2022.09.004

Cited by 5 publications

(7 citation statements)

References 45 publications

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“…However, their coverage size is limited to within 1 × 1 cm, making them unsuitable for medium-sized fingertip soft tissue losses. This limitation prompted Venkataswami [ 22 ] to develop the oblique triangular flap for broader coverage, particularly for oblique lateral and medial fingertip losses. Nevertheless, even this flap cannot provide sufficient tissue for total skin pulp loss in the fingertip.…”

Section: Discussionmentioning

confidence: 99%

“…In our surgical approach, the donor-site skin defect on the palmar side of the finger is more amenable to application of a full-thickness skin graft. Post-operative flap removal leaves behind more soft tissue in the donor area compared to the fingertip rotation flap [ 22 ], promoting graft survival and preventing significant depression upon healing.…”

Section: Discussionmentioning

confidence: 99%

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Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

Zhu,

Zhou,

Zhang

et al. 2024

J Orthop Surg Res

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Purpose The reconstruction of medium-sized soft tissue defects of the fingertip remains a challenge for hand surgeons. The aim of this study was to compare the outcomes of modified triangular neurovascular unilateral advancement flap and digital artery dorsal perforator flap in the treatment of this injury. Methods From May 2018 to May 2022, 70 patients with medium-sized volar soft tissue defects were enrolled. The patients were divided into two groups based on the flap type: modified triangular neurovascular unilateral advancement flap (Group A) and digital artery dorsal perforator flap (Group B). The debridement times, defect size, operation time, and flap survival rate were recorded. At follow-up, hand function, aesthetics, and complications were evaluated. Function was evaluated using the TAM score. The aesthetics of the reconstructed and donor sites were assessed using the vancouver scar scale (VSS). The static two-point discrimination of the finger pulp served as a measure of tactile agnosia. Results A total of 10 patients were lost to follow-up for various reasons, resulting in 30 cases remaining in each group. The general information of the two groups showed no significant differences in age, sex, injury side, cause of injury, time from injury to surgery, and operation time (P > 0.05). Additionally, the debridement times and size of the defect were similar between the groups (P > 0.05). However, the operation time was significantly shorter in Group A compared to Group B (P = 0.001). With regard to complications, there was no significant difference between them. At one-month follow-up, TAM scores indicated that Group B performed significantly better than Group A. However, at the final follow-up period, there was no significant difference in TAM scores between the two groups. When considering the VSS, significant differences were observed between the two groups in both the reconstructed site and donor site. Conclusion Both flaps can effectively repair medium-sized fingertip defects. Furthermore, the modified triangular neurovascular unilateral advancement flap offers anatomical reconstruction possibilities, ensuring satisfactory sensation and cosmetic contour.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

Zhu,

Zhou,

Zhang

et al. 2024

J Orthop Surg Res

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“…Stable and sensate soft tissue coverage is indicated in these types of injuries. There are many local and regional flaps which have been described, including cross finger flaps, reverse dorsal metacarpal artery flaps, V-Y advancement flaps, and free toe pulp to finger transfer flaps (1,2,3,4).…”

Section: Discussionmentioning

confidence: 99%

“…Distally Based, Axial Pattern, Perforator, Double Thenar Flaps Sri Lanka Journal of Medicine Vol. 33 No 1,…”

mentioning

confidence: 99%

Double, Distally Based, Axial Pattern, Distal Perforator Thenar Flap; A Case Report

Rafique,

Arshad

2024

SL J. Med.

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The provision of the glabrous skin with acceptable sensation is the main objective of any fingertip reconstruction. Thenar flaps can be medially based, laterally based and proximally based. However, all of them are randomly based. A distally based, axial pattern thenar flap could provide stable, like-with-like, palmar skin to the fingertip of an injured distal phalanx. We present a double, distally based axial pattern thenar flap, which we used to simultaneously reconstruct two fingers.

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“…The outcome of DAPF have been reported. However, there is a paucity of evidence regarding the versatility and survivability of DAPF for resurfacing finger defects of the hand [16,38] .…”

Section: Discussionmentioning

confidence: 99%

Digital Artery Perforator Flap for Fingers Reconstruction: A Meta-Analysis Study with Clinical Cases

Elkhwas,

Fareed,

El-Mofty

2024

International Journal of Medical Arts

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Article informationBackground: Local perforator flaps represent a new era for resurfacing soft-tissue defects of the hand. They provide durable coverage using flaps harvested from the closed vicinity of the defect. Digital artery perforator flaps [DAPF] have been recently used for finger reconstruction.Purpose: This meta-analysis study with clinical cases was conducted to reveal the surgical and cosmetic outcomes of DAPF for reconstructing soft-tissue defects of the digits. Methods: A systematic literature review was executed up to 1 April 2022. All clinical studies that included patients with finger defects and receiving DAPF for resurfacing finger defects were included. The flap survival rate and the rate of DAPF-related complications were evaluated. Results: The present study included eleven articles comprehending 403 patients with 440 reconstructed finger defects. The rate of flap survival was 93.1% [95CI% 89.7%, 95.5%, p<0.001] while the rate of flap congestion was 17.3% [95CI% 6.8%, 37.6%, p=0.004]. Furthermore, the rate of flap necrosis was 8.9% [95CI% 5.7%, 13.7%, P<0.001] and the rate of superficial epidermolysis was 4.7% [95CI% 0.2%, 10.8%, P<0.001]. Conclusion:The DAPF is a reliable procedure for reconstructing soft-tissue defects in the fingers. It provides stable coverage with satisfactory functional and surgical outcomes. It is a convenient addition to the armamentarium for covering soft-tissue defects of the digits.

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Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options

Cited by 5 publications

References 45 publications

Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

Double, Distally Based, Axial Pattern, Distal Perforator Thenar Flap; A Case Report

Digital Artery Perforator Flap for Fingers Reconstruction: A Meta-Analysis Study with Clinical Cases

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